Risk Of Wrist Fracture Research Articles

Social inequality and fractures-secular trends in the Danish population: a case-control study.

We explored whether the risk of hip, humerus, and wrist fracture was associated with markers of inequality using data from Danish health registries. All patients 50years or older with a primary hip (ICD10 S720, S721, S722, and S729) humerus (ICD10S422, S423, S424, S425, S426, and S427), or wrist (ICD10: S52) fracture were identified from 1/1/1995 to 31/12/2011. Fracture patients were matched 1:1 by age, sex, and year of fracture, to a non-fracture control. Markers of inequality were as follows: income (fifths); marital status (married, divorced, widowed, or unmarried); area of residence (remote, rural, intermediate, or urban). Conditional logistic regression was used to investigate associations between these exposures, and risk of fracture, adjusting for covariates (smoking, alcohol, and Charlson co-morbidity). Interactions were fitted between exposure and covariates where appropriate. A total of 189,838 fracture patients (37,500 hip, 45,602 humerus, and 106,736 wrist) and 189,838 controls were included. Mean age was 73.9years (hip), 67.5years (humerus), and 65.3years (wrist). High income (5th quintile) was significantly associated with a lower odds ratio of all three fractures, compared to average income (3rd quintile). Married subjects had a significantly decreased odds ratio across all three fractures. However, no overall secular difference was observed regarding the influence of the markers of inequality. In conclusion, we have demonstrated important, stable associations between social inequality, assessed using income, marital status, and area of residence, and fracture at the population level. These findings can inform approaches to healthcare, and suggest that much thought should be given to novel interventions aimed especially at those living alone, and ideally societal measures to reduce social inequality.

The epidemiology of wrist fractures in older men: the Osteoporotic Fractures in Men (MrOS) study.

To calculate the incidence of wrist fractures and their risk factors in older community-dwelling men from the US Osteoporotic Fractures in Men (MrOS) study. Using triannual postcards, we identified incident wrist fractures (centrally confirmed by radiology) in men aged ≥ 65. Potential risk factors included the following: demographics, lifestyle, bone mineral density (BMD), selected medications, biomarkers, and physical function and performance measures. Both baseline and time-varying models were adjusted for age, race/ethnicity, MrOS geographic location, and competing mortality risks. We observed 97 incident wrist fractures among 5875 men followed for an average of 10.8years. The incidence of wrist fracture was 1.6 per 1000 person-years overall and ranged from 1.0 among men aged 65-69 to 2.4 among men age ≥ 80. Significant predictors included the following: fracture history after age 50 [hazard ratio (95% CI): 2.48 (1.65, 3.73)], high serum phosphate [1.25 (1.02, 1.53)], use of selective serotonin receptor inhibitor (SSRI) [3.60 (1.96, 6.63), decreased right arm BMD [0.49 (0.37, 0.65) per SD increase], and inability to perform the grip strength test [3.38 (1.24, 9.25)]. We did not find associations with factors commonly associated with wrist and other osteoporosis fractures like falls, diabetes, calcium and vitamin D intake, and alcohol intake. Among these older, community-dwelling men, we confirmed that fracture history is a strong predictor of wrist fractures in men. Medications such as SSRIs and corticosteroids also play a role in wrist fracture risk. We identified novel risk factors including kidney function and the inability to perform the grip strength test.

Wrist malpractice claims in Northern Norway 2005–2014. Lessons to be learned

ABSTRACTRough weather conditions in the subarctic areas of Norway may influence on the risk of wrist fracture. We implemented data from the Norwegian System of Patient Injury Compensation (NPE). All claims due to wrist surgery, performed at the public hospitals in Northern Norway, during 2005-2014 were analyzed. We employed the ICD-10 classification codes S52.5 (fracture of distal end of radius) and S52.6 (fracture of distal end of radius and ulna). Treatment was defined by NCSP codes. 84 patients (0.3%) complained. Females complained four times more often than males did (P = 0.005) and received five times more frequently a compensation (P < 0.001). NPE accepted 34 claims (40%) for injury compensation (0.1% of patients). The percentage of claims accepted for compensation decreased from 48% to 30% during study period, probably due to delay in filling claims. The main causes of complains were pain, reduced range of motion, malfunction and weakness (35/84). The main causes of compensation were “operative treatment should have been performed” (14/34) and “wrong operative method applied” (13/34). The mean amount per compensation was €14,927 (€0–€52,995). Stonger focus on quality of care, updated guidelines and shared decission-making may reduce the number og complains and compensations.

Carotenoid dietary intakes and plasma concentrations are associated with heel bone ultrasound attenuation and osteoporotic fracture risk in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk cohort.

Carotenoids are found in abundance in fruit and vegetables, and may be involved in the positive association of these foods with bone health. This study aimed to explore the associations of dietary carotenoid intakes and plasma concentrations with bone density status and osteoporotic fracture risk in a European population. Cross-sectional analyses (n 14 803) of bone density status, using calcaneal broadband ultrasound attenuation (BUA) and longitudinal analyses (n 25 439) of fracture cases were conducted on data from the prospective European Prospective Investigation into Cancer and Nutrition-Norfolk cohort of middle-aged and older men and women. Health and lifestyle questionnaires were completed, and dietary nutrient intakes were derived from 7-d food diaries. Multiple regression demonstrated significant positive trends in BUA for women across quintiles of dietary α-carotene intake (P=0·029), β-carotene intake (P=0·003), β-cryptoxanthin intake (P=0·031), combined lutein and zeaxanthin intake (P=0·010) and lycopene intake (P=0·005). No significant trends across plasma carotenoid concentration quintiles were apparent (n 4570). The Prentice-weighted Cox regression showed no trends in fracture risk across dietary carotenoid intake quintiles (mean follow-up time 12·5 years), except for a lower risk for wrist fracture in women with higher lutein and zeaxanthin intake (P=0·022); nevertheless, inter-quintile differences in fracture risk were found for both sexes. Analysis of plasma carotenoid data (mean follow-up time 11·9 years) showed lower hip fracture risk in men across higher plasma α-carotene (P=0·026) and β-carotene (P=0·027) quintiles. This study provides novel evidence that dietary carotenoid intake is relevant to bone health in men and women, demonstrating that associations with bone density status and fracture risk exist for dietary intake of specific carotenoids and their plasma concentrations.

Gout and Risk of Fracture in Women: A Prospective Cohort Study.

Uric acid may be linked to bone health through its antioxidant or prooxidant effects, thereby affecting bone resorption and formation, or through its dual inhibition of vitamin D activation and parathyroid hormone production. Results of prior studies on the relationship between uric acid and bone mineral density have been conflicting. This prospective study was undertaken to examine the relationship between gout, a disease characterized by hyperuricemia and inflammation, and risk of hip or wrist fracture in women. We conducted a prospective observational study of gout and risk of incident wrist and hip fracture in women participating in the Nurses' Health Study (n = 103,799 at baseline, with 14 years of follow-up for the wrist fracture analysis and 22 years of follow-up for the hip fracture analysis). Gout history and incident cases of wrist and hip fracture were assessed by biennial questionnaire. Cox proportional hazards models were used to simultaneously adjust for potential confounders. In this cohort, there were 3,769 incident wrist fractures (1990-2004) and 2,147 incident hip fractures (1990-2012), with 107 wrist fractures and 117 hip fractures occurring in participants with gout. In those women with a history of gout compared with women without gout, the multivariable-adjusted relative risk of wrist fracture was 1.12 (95% confidence interval [95% CI] 0.92-1.36) and the multivariable-adjusted relative risk of hip fracture was 1.38 (95% CI 1.14-1.68). In women, a history of gout is associated with a modestly increased risk of hip fracture, but not significantly associated with a risk of wrist fracture.

Increasing Level of Leisure Physical Activity Could Reduce the Risk of Hip Fracture in Older Women: A Dose-Response Meta-analysis of Prospective Cohort Studies.

We carried out the study to investigate and quantitatively assess the potential association between current level of physical activity and the risk of osteoporosis hip fracture in older women. Relevant publications before October 2015 were identified using the PubMed and Ovid searching tools. A dose-response meta-analysis was carried out to combine and analysis results. Fourteen prospective studies were included in the meta-analysis. A general analysis of 9 studies showed a significant inverse relationship between increasing level of physical activity and risk of hip fracture in older women [relative risk (RR) = 0.93, 95% confidence interval (95% CI): 0.91-0.96]. The result of a sensitivity analysis was consistent with the general analysis (RR = 0.94, 95% CI: 0.93-0.96). The association between increasing level of physical activity and risk of wrist fracture was not statistically significant in a general analysis of three studies (RR = 1.004, 95% CI: 0.98-1.03). A potential direct association between increasing level of physical activity and risk of wrist fracture was observed after removing 1 study with the greatest weight (RR = 1.01, 95% CI: 1.00-1.03). No significant publication bias was observed in our analysis. Our results show that increasing level of physical activity within an appropriate range may reduce the risk of hip fracture but not the risk of wrist fracture in older women.

The predicted lifetime costs and health consequences of calcium and vitamin D supplementation for fracture prevention-the impact of cardiovascular effects.

Some studies indicate that calcium supplementation increases cardiovascular risk. We assessed whether such effects could counterbalance the fracture benefits from supplementation. Accounting for cardiovascular outcomes, calcium may cause net harm and would not be cost-effective. Clinicians may do well considering cardiovascular effects when prescribing calcium supplementation. Accounting for possible cardiovascular effect of calcium and vitamin D supplementation (CaD), the aims of this study were to assess whether CaD on balance would improve population health and to evaluate the cost-effectiveness of such supplementation. We created a probabilistic Markov simulation model that was analysed at the individual patient level. We analysed 65-year-old Norwegian women with a 2.3% 10-year risk of hip fracture and a 9.3% risk of any major fracture according to the WHO fracture risk assessment tool (FRAX®). Consistent with a recent Cochrane review, we assumed that CaD reduces the risk of hip, vertebral, and wrist fractures by 16, 11, and 5%, respectively. We included the increased risk of acute myocardial infarction (AMI) and stroke under a no-, medium-, and high-risk scenario. Assuming no cardiovascular effects, CaD supplementation produces improved health outcomes resulting in an incremental gain of 0.0223 quality-adjusted life years (QALYs) and increases costs by €322 compared with no treatment (cost-effectiveness ratio €14,453 per QALY gained). Assuming a Norwegian cost-effectiveness threshold of €60,000 per QALY, CaD is likely to be considered a cost-effective treatment alternative. In a scenario with a medium or high increased risk of cardiovascular events, CaD produces net health losses, respectively, -0.0572 and -0.0784 QALY at additional costs of €481 and €1033. We conclude that the magnitude of potential cardiovascular side effects is crucial for the effectiveness and cost-effectiveness of CaD supplementation in elderly women.

Bone loss and wrist fractures after withdrawal of hormone therapy: The 15-year follow-up of the OSTPRE cohort

ContextLong-term bone mineral density (BMD) or fracture incidence changes after withdrawal of postmenopausal hormone therapy (HT) are not well known. ObjectiveTo study long-term postmenopausal bone loss and incidence of wrist fracture in respect to duration and withdrawal of self-reported HT. Design/settingA 15-year follow-up of the population-based prospective OSTPRE cohort in Kuopio, Finland. ParticipantsWomen (mean baseline age 53.4 years, range 48.1–59.6) were divided into four groups based on duration of HT: (1) never users (non-HT); (2) those who had used HT only throughout the 1st 5-year period (HT5); (3) throughout the first 10-years (HT10); (4) those who used HT throughout the entire 15-year follow-up (HT15). Outcome measuresFemoral (n=857) and spinal (n=599) BMD measurements with dual X-ray absorptiometry (DXA) were carried out at 5-year intervals in 1989–2004. Wrist fracture incidence in 1989–2004 was studied in a population of 5119 women. ResultsThe adjusted spinal BMD (L2–L4) changes by HT use during the entire 15-year follow-up were −4.8% for non-HT (p<0.0001), −4.2% for HT5 (p=0.003), +0.02% for HT10 (p>0.05) and +3.2% for HT15 (p<0.0001) groups. The respective femoral bone losses were -8.6% for non-HT (p<0.0001), −7.9% for HT5 (p<0.0001), −2.5% for HT10 (p=0.010) and −0.2% for HT15 (p>0.05) groups. Comparing to non-HT group the risk of wrist fracture was reduced by 33% (p=0.045) in HT10 group and by 63% (p<0.0001) in HT15 group during the 15-year follow-up. ConclusionLong-term HT-use protects from bone loss. Thus, it reduces the incidence of osteopenia, osteoporosis and wrist fractures. Still, HT-use of less than 5 years did not have long-term bone protective effects, but a larger sample size is needed to confirm this result.

Nephrolithiasis and Risk of Incident Bone Fracture

Higher urine calcium is a common feature of calcium nephrolithiasis and may be associated with lower bone mineral density in individuals with kidney stones. However previous population based studies of kidney stones and the risk of bone fracture demonstrate conflicting results. We examined independent associations between a history of kidney stones and incident fracture. We performed prospective studies using data from the Nurses' Health Study of 107,001 women with 32 years of followup and the Health Professionals Follow-up Study of 50,982 men with 26 years of followup. We excluded premenopausal women, men younger than 45 years and individuals who reported osteoporosis at baseline. Study outcomes were incident wrist (distal radius) or incident hip (proximal femur) fracture due to low or moderate trauma. Cox proportional hazards regression was used to adjust for multiple factors, including age, race, body mass index, thiazide use, supplemental calcium and dietary intakes. There were 4,940 wrist and 2,391 hip fractures in women, and 862 wrist and 747 hip fractures in men. All fractures were incident. The multivariable adjusted relative risk of incident wrist fracture in participants with a history ofkidney stones compared to participants without kidney stones was 1.18 (95%CI1.04-1.34) in women and 1.21 (95% CI 1.00-1.47) in men. The pooled multivariable adjusted relative risk of wrist fracture was 1.20 (95% CI1.08-1.33). The multivariable adjusted relative risk of incident hip fracture in participants with kidney stones was 0.96 (95% CI 0.80-1.14) in women and 0.92(95% CI 0.74-1.14) in men. The pooled multivariable adjusted relative risk of hip fracture was 0.94 (95% CI 0.82-1.08). Nephrolithiasis is associated with a significantly higher risk of incident wrist but not hip fracture in women and men.

Bone Mineral Density as a Predictor of Subsequent Wrist Fractures: Findings From the Women's Health Initiative Study.

Wrist fractures are common among postmenopausal women. Associations of bone mineral density (BMD) and 10-year predicted risk of major osteoporotic fracture (MOF) with wrist fractures are poorly characterized. The objective was to examine associations between the Fracture Risk Assessment Tool (FRAX)-predicted risk of MOF, BMD, BMD change, and wrist fracture. This was a prospective observational study with a mean follow-up of 8.5 years. This study included 40 US centers. A total of 11 392 participants from the Women's Health Initiative BMD Cohort aged 50-79 years at baseline were included in this study. None. The goal was to measure incident wrist fracture. A FRAX-predicted MOF risk ≥9.3% identified 17% of the women aged <65 years who subsequently experienced wrist fracture. Each one standard deviation lower BMD was associated with higher wrist fracture risk, with adjusted hazard ratio (95% confidence interval) of 1.66 (1.42-1.93) for femoral neck (FN) BMD and 1.45 (1.28-1.64) for lumbar spine BMD. Compared with FN BMD T score ≥ -1.0, wrist fracture adjusted hazard ratios (95% confidence interval) were: 1.51 (1.06-2.16) for a T score between -1.01 and -1.49; 1.93 (1.36-2.72) for T score between -1.50 and -1.99; 2.52 (1.77-3.60) for a T score between -2.00 and -2.49; and 2.65 (1.78-3.95) for a T score ≤ -2.5. Decrease in FN BMD between baseline and year 3 was associated with increased risk of subsequent wrist fracture; however, change in lumbar spine BMD was not. Lumbar spine and femoral neck BMDs were associated with incident wrist fracture, but the FRAX threshold recommended to identify screening candidates did not identify the majority of women who subsequently experienced wrist fracture. Improved understanding of determinants of wrist fractures is warranted.

Association of history of fracture with prehypertension and hypertension: a retrospective case-control study.

BackgroundHypertension is one of the most common encountered medical comorbidities after hip fracture. Whether fracture is a potential risk factor for hypertension remains poorly understood. The aim of our study was to examine the risk of prehypertension and hypertension in the participants with and without a history of fracture.MethodsWe conducted a retrospective case–control study of 3,515 men and women aged between 20 and 85 years old from the National Health and Nutrition Examination Survey 2005–2006. History of fracture was collected via structured questionnaire. Multiple blood pressure readings (up to 4 times) were performed at interview, and an average of blood pressure readings were used to define prehypertension and hypertension.ResultsAmong 3,515 participants, 30% (n = 1074), 1.4% (n = 48) and 10% (n = 347) of them had a history of any, hip and wrist fracture, respectively. The positive association between history of any, hip and wrist fracture and prehypertension was similar to the association between history of any, hip and wrist fracture and hypertension in both unadjusted and adjusted model. In the unadjusted model, history of any, hip and wrist fracture was each associated with increased overall risk of prehypertension and hypertension (odds ratio [OR] = 1.61, 95% confidence interval [CI] = 1.38-1.89 for any fracture; OR = 3.57, 95% CI = 1.60-8.00 for hip fracture; and OR = 1.82, 95% CI = 1.41-2.36 for wrist fracture). However, in multivariable adjusted model, only the positive association between history of wrist fracture and overall risk of prehypertension and hypertension remained significant (OR = 1.48, 95% CI = 1.10-1.99).ConclusionsThere was no overall independent association between history of fracture, and risk of prehypertension and hypertension. Although history of fracture overall may not directly cause hypertension, people with a history of wrist fracture can be potentially benefitted from hypertension control at the early stage.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-015-0544-z) contains supplementary material, which is available to authorized users.

Mo1153 Gender Differences in Proton Pump Inhibitors (PPI) Dose Requirements for GERD: A Double-Blind Randomized Trial

Purpose: Current literature on the risk of fractures in patients on proton pump inhibitors (PPI) has yielded mixed results. This study evaluated the association between PPI use and incidence of osteoporotic fractures in male patients. Methods: Retrospective chart review was conducted at the Phoenix Veterans Affairs Health Care System from January 1, 1995 to July 23, 2012 for this case control study. Inclusion criteria included all male patients who were diagnosed as having a hip, wrist or spine fracture. A 3:1 sample of controls (patients without fractures) was drawn from the same period. Demographic information including age, body mass index (BMI), ethnicity, tobacco, and alcohol use were collected for all patients. Thiazides, bisphosphonates and steroid use data were also collected for patients with a fracture and PPI use. Results: A total of 246 male patients, mean age 65.3 years, suffered a hip (20%), wrist (30%) or spine (50%) fracture during the study period. Of these, 33 (13.4%) used chronic PPI's prior to the fracture. Among patients without fractures, 107 (14.1%) were using PPI's. Increasing BMI and PPI use are protective against hip fracture, (p<0.001). PPI's are protective against spine fracture and more so with increasing age, (p<0.05). For males not on PPI, incidence of spine fracture significantly increases with age. For those not taking bisphosphonate, taking PPIs reduces the risk of wrist fracture (p<0.001). Alcohol use was higher in the fracture group (74% vs 59%), and smoking rates were similar in both groups: 70% and 66% with and without fractures, respectively. Average BMI was 26 in both groups. Multivariable logistic regression modeling revealed a significant association of fracture with age and BMI, which depend on the fracture location. Conclusion: This study found no significant evidence of an association between chronic PPI use and hip, wrist or spine fracture in men over 55 years old. PPI use appears to be protective.

Evidence-based review of Colles’ fracture

Background A Colles’ fracture occurs as a transverse fracture of the metaphyseal region of the distal radius, approximately 25–40 mm proximal to the radio-carpal joint, and is associated with dorsal displacement and angulation of the distal fragment. Other features include radial shortening and palmar tilt. Key radiological measurements usually noted are that of radial length (normally 11 mm), dorsal angulation of the distal radius (normally 10° volar angulation) and radial inclination (normally 22°). A Colles’ fracture is one of the most common types of osteoporotic fractures seen, especially in females above the age of 50. Incidence of men vs. women over the age of 35 was 9/10,000 vs. 37/10,000, respectively. Management Conservative management is commonly an option in stable or minimally displaced fractures which are described as ≤2 mm loss of radial height, ≤5° change in radial inclination and ≤10° of dorsal angulation. This can be managed in a plaster cast for five to six weeks. Furthermore, age of &gt;60 years was found to be the most important factor in predicting whether a reduced unstable fracture would redisplace. Kirschner-wire fixation is a useful and simple operative method to help stabilise fragments that are not severely comminuted. This option was found to be better than plaster cast management alone, but was associated with surgical complications such as infection and nerve injuries. A more common management option utilised for unstable fractures today is open reduction and internal fixation using either dorsal or volar plates. Dorsal plates are less commonly used due to increased risk of volar collapse and tendon rupture with up to a 22% removal of implant rate due to tendon irritation. Volar plates are more popular as they allow a more stable fixation and thus early mobilisation with a better radiological outcome when compared against K-wire fixation. They are also associated with a lower incidence of tendon complications. External fixation management options may either be bridging or nonbridging in regards to the radio-carpal joint. Immobilising the wrist with a bridging external fixation device can be an option when managing a severely comminuted fracture without a large enough distal fragment to secure a distal pin. However, dorsal malunion was six times more likely when compared against a nonbridging option. Though studies showed external fixation devices provided better radiological outcomes when compared to conservative management, there is insufficient evidence to conclude that long-term functional outcomes are also improved. Prevention Often a fracture of this nature is considered as one of the first signs of osteoporosis in a middle-aged adult. Hormone replacement therapies and use of bisphosphonate therapy have been proven to reduce the risk of osteoporotic fractures with alendronate being found to significantly reduce the risk of spine, hip and wrist fractures in postmenopausal women with a mean age of 70 years. Incorporation of other health care professionals such as physiotherapists and occupational therapists is also of vital importance to ensure osteoporotic patients are at a lower risk of sustaining falls.

Biomechanical assessment of the connection between risk of wrist fracture and the dumbbell chest press exercise performed on an exercise ball

Multiple incidents of exercise balls bursting during a dumbbell chest press have been reported. This study quantified the dynamics of the dumbbell chest press performed on such balls and the force applied throughout the exercise cycle. To do so, a well-documented case was replicated using subjects of similar weight, background and athletic ability in the same dumbbell chest press motion. Subjects were instructed to perform repetitions on the exercise balls at both a self-selected pace and at maximal speed using various masses. Dynamic measurements were made to record ball loading, ball loading rate, ball compression, and kinematics of the subjects. Peak loads averaged 2084 N in the case of fast trials and 1815 N for self-selected speed trials. Biomechanical aspects of injury causation and the safe use of exercise balls are discussed throughout the products life cycle; from design and manufacturing to the conditioning professional and athlete end user.

Risk of osteoporotic fracture after steroid injections in Medicare patients

(HR=0.99) or LSJI (HR=0.96). Long term steroid use increased spine fracture risk in ESI (HR=1.86) and LJSI patients (HR=1.41). Osteoporotic hip fracture risk was influenced by age, race, sex, CCMI, Cushing’s disease, LJSI (HR=0.95) and TSI (HR=0.95), but not ESI. Osteoporotic wrist fracture risk was influenced by age, race, sex, CCMI, LJSI (HR=0.91), but not by ESI or TSI. Conclusions Analysis of patients in the Medicare database showed that ESI, TSI or LJSI decreased osteoporotic spine fracture risk; but this may not be clinically relevant. Successive ESIs did not influence osteoporotic hip or wrist fracture risk, while LJSIs reduced the risk. Prolonged steroid exposure increases spine fracture risk in ESI and LJSI patients. Acute exposure to exogenous steroids via the epidural space, transforaminal space or large joints does not seem to increase the risk of an osteoporotic fracture of the spine, hip or wrist.

Risk of Osteoporotic Fracture after Steroid Injections in Medicare Patients

(HR=0.99) or LSJI (HR=0.96). Long term steroid use increased spine fracture risk in ESI (HR=1.86) and LJSI patients (HR=1.41). Osteoporotic hip fracture risk was influenced by age, race, sex, CCMI, Cushing’s disease, LJSI (HR=0.95) and TSI (HR=0.95), but not ESI. Osteoporotic wrist fracture risk was influenced by age, race, sex, CCMI, LJSI (HR=0.91), but not by ESI or TSI. Conclusions Analysis of patients in the Medicare database showed that ESI, TSI or LJSI decreased osteoporotic spine fracture risk; but this may not be clinically relevant. Successive ESIs did not influence osteoporotic hip or wrist fracture risk, while LJSIs reduced the risk. Prolonged steroid exposure increases spine fracture risk in ESI and LJSI patients. Acute exposure to exogenous steroids via the epidural space, transforaminal space or large joints does not seem to increase the risk of an osteoporotic fracture of the spine, hip or wrist.

Increased risk of hip fractures in patients with dementia: a nationwide population-based study.

BackgroundDementia has been associated with an increased risk of hip fracture. However, little research has been conducted on the impact of dementia on wrist or vertebral fracture development. The aim of this study was to investigate whether dementia is a risk factor for different types of fracture in Taiwan.MethodsThe study sample was drawn from Taiwan’s National Health Insurance Research Database of reimbursement claims, and comprised 1408 patients who visited ambulatory care centers or were hospitalized with a diagnosis of dementia. The comparison group consisted of 7040 randomly selected individuals. Cox proportional hazard regression model was used to examine associations between dementia and the risk of different types of fracture.ResultsDuring a 3-year follow-up period, 264 patients with dementia (18.75%) and 1098 patients without dementia (15.60%) developed fractures. Dementia was independently associated with increased risk of hip fracture [adjusted hazard ratio (HR) 1.92, 95% CI 1.48–2.49]. Patients with dementia and osteoporosis had the highest risk of developing hip fracture (adjusted HR 2.27, 95% CI 1.28–4.01). Dementia did not increase wrist fracture or vertebral fracture risk when compared to the control group, even in patients with osteoporosis.ConclusionsIndividuals with dementia are at greater risk of developing hip fracture, particularly if they also have osteoporosis. Early mental screening programs and health education should be initiated to decrease disability and dependence in patients with dementia.

Obesity and fractures.

Until recently obesity was believed to be protective against fractures. However, a report from a Fracture Liaison Clinic in the UK (2010) reported a surprisingly high proportion of obese postmenopausal women attending the clinic with fractures, and in the GLOW study (2011), a similar prevalence and incidence of fractures in obese and non-obese postmenopausal women was observed. Subsequently, other studies have demonstrated the importance of obesity in the epidemiology of fractures. Obese women are at increased risk of fracture in ankle, leg, humerus, and vertebral column and at lower risk of wrist, hip and pelvis fracture when compared to non-obese women. In men, it has been reported that multiple rib fractures are associated with obesity. Furthermore, falls appear to play an important role in the pathogenesis of fractures in obese subjects. Regarding hip fracture and major fractures, the FRAX algorithm has proven to be a useful predictor in obese individuals. Obese people are less likely to receive bone protective treatment; they have a longer hospital stay and a lower quality of life both before and after fracture. Moreover, the efficacy of antiresorptive therapies is not well established in obese people. The latter is a field for future research.

Magnesium intake, bone mineral density, and fractures: results from the Women’s Health Initiative Observational Study

Magnesium is a necessary component of bone, but its relation to osteoporotic fractures is unclear. We examined magnesium intake as a risk factor for osteoporotic fractures and altered bone mineral density (BMD). This prospective cohort study included 73,684 postmenopausal women enrolled in the Women's Health Initiative Observational Study. Total daily magnesium intake was estimated from baseline food-frequency questionnaires plus supplements. Hip fractures were confirmed by a medical record review; other fractures were identified by self-report. A baseline BMD analysis was performed in 4778 participants. Baseline hip BMD was 3% higher (P < 0.001), and whole-body BMD was 2% higher (P < 0.001), in women who consumed >422.5 compared with <206.5 mg Mg/d. However, the incidence and RR of hip and total fractures did not differ across quintiles of magnesium. In contrast, risk of lower-arm or wrist fractures increased with higher magnesium intake [multivariate-adjusted HRs of 1.15 (95% CI: 1.01, 1.32) and 1.23 (95% CI: 1.07, 1.42) for quintiles 4 and 5, respectively, compared with quintile 1; P-trend = 0.002]. In addition, women with the highest magnesium intakes were more physically active and at increased risk of falls [HR for quintile 4: 1.11 (95% CI: 1.06, 1.16); HR for quintile 5: 1.15 (95% CI: 1.10, 1.20); P-trend < 0.001]. Lower magnesium intake is associated with lower BMD of the hip and whole body, but this result does not translate into increased risk of fractures. A magnesium consumption slightly greater than the Recommended Dietary Allowance is associated with increased lower-arm and wrist fractures that are possibly related to more physical activity and falls.

Incident long-term warfarin use and risk of osteoporotic fractures: propensity-score matched cohort of elders with new onset atrial fibrillation.

Association between warfarin use and fracture risk is unclear. We examined the association between long-term warfarin use and fracture risk at the hip, spine, and wrist in elders. No significant association was found between long-term warfarin use and fracture risk, despite biological plausibility. Prior studies examining the association of warfarin use and osteoporotic fractures have been conflicting, potentially related to methodological limitations. Thus, we examined the association of long-term warfarin use with risk of hip, spine, and wrist fractures among older adults with atrial fibrillation, attempting to address prior methodologic challenges. We included men and women ≥ 65 years of age with incident atrial fibrillation and without prior history of fractures from The Health Improvement Network followed between 2000 and 2010. Long-term warfarin use was defined in two ways: (1) warfarin use ≥ 1 year; (2) warfarin use ≥ 3 years. Propensity-score matched cohorts of warfarin users and nonusers were created to evaluate the association between long-term warfarin use and risk of hip, spine, and wrist fractures separately as well as combined, using Cox-proportional hazards regression models. Among >20,000 participants with incident atrial fibrillation, the hazard ratios (HR) for hip fracture with warfarin use ≥ 1 and ≥ 3 years, respectively, were 1.08 (95%CI 0.87, 1.35) and 1.13 (95% CI 0.84, 1.50). Similarly, no significant associations were observed between long-term warfarin use and risk of spine or wrist fracture. When risk of any fracture was assessed with warfarin use, no association was found [HR for warfarin use ≥ 1 year 0.92 (95%CI 0.77, 1.10); HR for warfarin use ≥ 3 years 1.12 (95%CI 0.88, 1.43)]. Long-term warfarin use among elders with atrial fibrillation was not associated with increased risk of osteoporotic fractures and therefore does not appear to necessitate additional surveillance or prophylaxis.